Drug Topics Voices 08-10-2015

August 10, 2015

Letters, e-mails, posts, and comments from Drug Topics readers

COI alert

Re: “Pharmaceuticals and Pharmaphobes” [Thomas P. Stossel, MD, July 14]:

Dear Dr. Stossel, pardon me! There is a myth regarding conflicts of interest? Really? How about you? Got any COIs to report? Since it is a myth, please reveal your financial connections with Pharma.

I am flabbergasted that a member of the medical profession actually is standing up and defending conflicts of interest. Excuse me while I look for your name on The List(http://www.propublica.org/article/reporting-recipe-dollars-for-docs).

Which LDL did Vytorin lower? The good LDL or the bad LDL or oxidized LDL? Did it raise the bad HDL or the good HDL? I bet they didn’t differentiate. What effect did the drug have on Lp(a)?

Finally: What effect does the drug have on risk of dying, what is the NNT and what is the NNH? And how much does it cost to treat the inevitable diabetes caused by the drug?

By the way, what is an oncologist doing using a statin study as an example?

Mark Burger, PharmDWindsor, Calif.

Off the charts

Re: “Top 20 states for pharmacy robberies” [Mark Lowery, June 30]:

If you do the calculation of robberies by 1 million population, you will discover that Indiana is way off the scale. Wisconsin and Indiana have similar populations, whereas California has six to seven times the population.

Steve Ariensposted at drugtopics.com

Business head needed

Re: “Change will come when pharmacists take action” [Larry LaBenne, Final Word, June 10]:

When you don’t control or understand the financial backbone of your profession it’s not really your profession. Clinical knowledge is great and necessary for licensure, but it’s the businessman who creates the environment in which that knowledge can be parlayed into profitability.

The reason that our profession is in such dire straits is because 95% of us don’t have a knowledge or understanding of the business of pharmacy and the detestable role that PBMs have in our profession’s demise.

Brian Petrucciposted at facebook.com/drugtopics

Do the math

Re: “Pharmacist interventions improve diabetes outcomes,” [Mark Lowery, March 25]:

A breakdown of results from the study: The free A1c testing and pharmacist consultation was offered to 68,000 eligible members, completely free of charge. Only 457 people responded - less than 1%! I wonder how many would show up if they had to pay even a small fee for the testing?

Out of the 457 respondents, only 82 made it to a follow-up appointment, less than 20%. Of these 82, fewer than half showed a clinically significant A1c reduction, so only 8% of the 457 people who showed up initially demonstrated any significant improvement - out of 68,000. Not that impressive, especially considering the service was being offered for free.

The study makes a statement that is completely false and misleading: “The proportion of patients that met target A1c increased from 9% (7/82) at their first appointment to 26% (21/82) at their follow-up appointment. In other words, the number of patients that reached A1c target tripled after only a 30-minute consultation with a Shoppers Drug Mart pharmacist (Figure 1).”

Notice how the authors attempt to take credit for the improvement in A1c - completely overlooking the fact that the improvement most likely came from the patient making an appointment with their physician and receiving medication or changes in medication.

The benefit did not come from the 30-minute pharmacist consultation; the benefit came from sending the patient to go see their doctor for therapy changes.

To summarize: What this study and most others like it actually show is the need for greater testing and screening of the public, followed simply by a referral to the doctor for those who need it. The real value here was the free A1c test, not the pharmacist consultation.

Anonymousposted at drugtopics.com

The one that haunts you

Re: “My most serious pharmacy mistake,” [Dennis Miller, July 1].

I guess I should be taken to the whipping post too. I have a patient who has been on Halcion 1 Q6H for migraine headaches. She has taken it that way for years. I admit that I did question it the first time it came across my counter. Since I have a history in my brain data base, would I question it if it came to me again? Probably.

My worst error was when I was an intern (40 years ago). Gentamycin dose of 39 mg. Didn’t catch that it was for an infant. No harm done, but I never forgot it.

Dr RHenryposted at drugtopics.com

What would you have done?

Several years ago, our pharmacy received an order for 5FU continuous infusion, written “300 mg/m2 per week, continuous infusion” and intended for a patient with advanced pancreatic cancer. The dose was given as prescribed for 12 weeks before the error was caught. Usually pancreatic cancer is rapidly fatal, but this patient showed marked improvement. The error? His 5-FU dose should have been 300 mg/m2 per day, not per week. He received 1/7th the protocol dose of 5-FU.

There was an immediate furor at our facility. The prescribing physician denied that he had written for such a low dose. The organization immediately conducted a retrospective review of the patient’s entire therapy. The results were hushed up. The patient’s dose of 5FU was immediately increased to 300 mg/m2/day. Within a week, his health began to fail, the tumor began to regrow, and he was lost to follow-up when he entered hospice care three weeks later.

The organization threatened everyone with termination and prosecution under HIPAA laws if details were ever discussed. Computer records became unavailable.

The incident tells me that the penalties of HIPAA and our extremely punitive legal system are working together to prevent the accidental discovery of new treatments for diseases.

Even though the error appeared to benefit the patient, the risk of a ruinous lawsuit and damage to institutional reputations led to the complete cover-up of a potentially promising new approach to treatment of this devastating cancer.

In the current legal environment, would you violate HIPAA on this one?

Anonymousposted at drugtopics.com